Ethical and Professional Considerations Providing Medical Evaluation and Care to Refugee Asylum Seekers

Asgary, Ramin; Smith, Clyde Lanford

doi:10.1080/15265161.2013.794876

Cited by 24 publications

(12 citation statements)

References 46 publications

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“…However, as emphasized by one study, clinical encounters are often complicated by inadequate communication between health professionals and patients [44]. Therefore, as suggested by another study [46], urgent training is required for practitioners and intercultural mediators to provide them with the skills needed for dealing with emotionally draining situations and to become familiar with international guidelines on providing care for victims of violence.…”

Section: Resultsmentioning

confidence: 99%

Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure

Chiarenza

Dauvrin

Chiesa

et al. 2019

BMC Health Serv Res

102

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Background In 2015 the increased migratory pressure in Europe posed additional challenges for healthcare providers. The aim of this study was to inform the development of a “Resource Package” to support European Union (EU) member states in improving access to healthcare for refugees, asylum seekers and other migrants. Methods A mixed method approach was adopted: i) interviews and focus groups were carried out to gather up-to-date information on the challenges the different healthcare providers were facing related to the refugee crisis; ii) to complement the results of the FGs, a literature review was conducted to collect available evidence on barriers and solutions related to access to healthcare for refugees and migrants. Results The different actors providing healthcare for refugees and migrants faced challenges related to the phases of the migration trajectory: arrival, transit and destination. These challenges impacted on the accessibility of healthcare services due to legislative, financial and administrative barriers; lack of interpretation and cultural mediation services; lack of reliable information on the illness and health history of migrant patients; lack of knowledge of entitlements and available services; lack of organisation and coordination between services. These barriers proved particularly problematic for access to specific services: mental health, sexual and reproductive care, child & adolescent care and victim of violence care. Conclusions The findings of this study show that solutions that are aimed only at responding to emergencies often lead to fragmented and chaotic interventions, devolving attention from the need to develop structural changes in the EU health systems. Electronic supplementary material The online version of this article (10.1186/s12913-019-4353-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure

Chiarenza

Dauvrin

Chiesa

et al. 2019

BMC Health Serv Res

102

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“…14 The new emphasis on such training for physicians and other health professionals indicates a recognition of the growing number of survivors of torture and other human rights violations living in the United States and the obligation of physicians to care for these individuals. 15 In light of the legal situation of asylum seekers, physicians conduct their evaluations in a unique context that calls for a strong collaboration between physicians and legal parties. Considering this collaborative necessity and given the significant gaps in knowledge regarding medical affidavits, the purpose of this qualitative study was to gather lawyers’ perspectives about the unmet need for evaluations, the features of effective medical/psychological affidavits, and the personal and systemic barriers that asylum seekers face.…”

Section: Introductionmentioning

confidence: 99%

“An absolutely necessary piece”: A qualitative study of legal perspectives on medical affidavits in the asylum process

Scruggs

Guetterman

Meyer

et al. 2016

Journal of Forensic and Legal Medicine

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A key challenge for asylum seekers in the United States is being able to provide evidence of prior persecution in their home countries. Medical/psychological affidavits corroborating applicants’ accounts often make the difference between successful and unsuccessful applications. The purpose of this study was to identify the unmet demand for and features of effective medical/psychological affidavits in the asylum process, as well as the personal and systemic barriers for asylum seekers. This is a qualitative study of semi-structured interviews with legal professionals who work in asylum law. Sixteen asylum lawyers and one Board of Immigration Appeals accredited representative practicing in the state of Michigan, United States, participated in this study. All participants noted that a vast majority of their asylum cases would benefit from a medical affidavit but that they have difficulty finding qualified physicians with experience writing such affidavits and testifying as expert witnesses. The major barriers to obtaining medical/psychological evaluations included inability to pay for services, lack of practitioner availability, and lack of practitioner training. The participants reported that features of a strong medical affidavit included clear, concise, and corroborative accounts that supported the applicant’s story from a diagnostic perspective and forensic descriptions that reinforced the credibility of the applicant. Several also noted that medical/psychological evaluations frequently would reveal additional details and incidents of trauma beyond those stated in the applicant’s preliminary statement. The study results suggest substantial unmet need for trained physicians to perform medical and psychological evaluations on a pro bono basis. Lawyers’ recommendations regarding effective medical affidavits and necessary ongoing support for asylum applicants should inform current efforts to improve physician and lawyer collaborations on asylum cases.

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“…This systematic review describes the complexity and variation in medical-legal partnerships for im/migrant populations in the United States. The overwhelming observation of the review is the significance of these partnerships to improve legal outcomes; ten out of ten articles that discussed the delivery of medical knowledge to legal cases described how people were more likely to receive positive legal outcomes when medical professionals contribute to legal proceedings [13][14][15][16][17][18][19][20][21][22]. The legitimatization of trauma and persecution through medical professionals in legal spaces may also be crucial for protecting the lives of migrants who have suffered greatly in both sending and receiving communities alike [13].…”

Section: Discussionmentioning

confidence: 99%

“…This involves recognizing how and why people may fear, not understand, or reject medical recommendations and the linguistic, cultural, gender, and personal differences between healthcare professional and patients that impede good care. The studies we reviewed emphasize institutional barriers—such as translation services, financial assistance, affordability, and access to psychiatric care—as well as psychiatric barriers, such as having medical professionals trained in trauma-informed care [ 13 – 16 , 18 , 21 , 24 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Medical-Legal Partnerships Serving Immigrant Communities in the United States

League

Donato

Sheth

et al. 2020

J Immigrant Minority Health

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The medical-legal partnership addresses social and political determinants of health. Yet, relatively little is known about best practices for these two service providers collaborating to deliver integrated services, particularly to im/migrant communities. To investigate evaluations of existing medical-legal partnerships in order to understand how they function together, what they provide, and how they define and deliver equitable, integrated care. We searched five databases (PubMed, Medline, Web of Science, HeinOnline, and Nexus Uni) using search terms related to "medical-legal partnerships", "migrants", and "United States". We systematically evaluated ten themes related to how medical and legal teams interacted, were situated, organized, and who they served. Articles were published in English between 2010 and 2019; required discussion about a direct partnership between medical and legal professionals; and focused on providing clinical care and legal services to im/migrant populations. Eighteen articles met our inclusion criteria. The most common form of partnership was a model in which legal clinics make regular referrals to medical clinics, although the reverse was also common. Most services were not co-located. Partnerships often engaged in advocacy work, provided translation services, and referred clients to non-medical providers and legal services. This review demonstrates the benefits of a legal-medical partnership, such as enhancing documentation and care for im/migrants and facilitating a greater attention to political determinants of health. Yet, this review demonstrates that, despite the increasing salience of such partnership, few have written up their lessons learned and best practices.

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Ethical and Professional Considerations Providing Medical Evaluation and Care to Refugee Asylum Seekers

Cited by 24 publications

References 46 publications

Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure

Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure

“An absolutely necessary piece”: A qualitative study of legal perspectives on medical affidavits in the asylum process

A Systematic Review of Medical-Legal Partnerships Serving Immigrant Communities in the United States

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